Provider Demographics
NPI:1073524740
Name:CHIPPS, BRADLEY ELLIOTT (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ELLIOTT
Last Name:CHIPPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 SECRET RAVINE PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4051
Mailing Address - Country:US
Mailing Address - Phone:916-453-8696
Mailing Address - Fax:916-453-8715
Practice Address - Street 1:5609 J STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-453-8696
Practice Address - Fax:916-453-8715
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38640207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C386400Medicare PIN
CAA36971Medicare UPIN